An  Example  of  Cooperation  with 
the  Chinese  in  Medical 
Education 


F.  C.  YEN,  M.D.,  D.T.M. 

CHANGSIIA,  CHINA 


Reprinted  from  The  Journal  of  the  American  Medical  Association 
April  24,  1915,  Rot.  LX1V,  pp.  1385-13X7 


t 


Copyright,  1915 
American  Medical  Association 
I ive  Hundred  and  Thirty-Five  North  Dearborn  Street 
CHICAGO 


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AN  EXAMPLE  OF  COOPERATION 
WITH  THE  CHINESE  IN 
MEDICAL  EDUCATION* 


F.  C.  YEN,  M.D.,  D.T.M. 

CHANGSHA,  CHINA 


The  leaders  in  medical  science  in  China  to-day  are 
agreed  that  in  medical  education  lies  the  strategic  basis 
for  future  development.  In  order  to  accomplish  the 
most  for  China  and  to  confer  a permanent  blessing 
on  her  people,  they  realize  the  necessity  of  conserving 
the  comparatively  insufficient  resources  of  men  and 
money,  and  of  utilizing  to  the  best  advantage  all  avail- 
able energy  and  effort  in  the  training  of  Chinese  doc- 
tors. With  the  limited  supply  of  men  and  money  from 
foreign  sources,  it  is  suicidal  to  spread  out  over  the 
whole  field  awaiting  to  be  occupied.  As  Dr.  Gillison 
said,  “Plant  all  the  hospitals  and  all  the  doctors  in 
civil  and  military  practice  in  Great  Britain  and  Ireland 
in  the  one  province  of  Szechuen,  and  provide  for  the 
rest  of  China  in  the  same  proportion,  and  you  have 
some  idea  of  the  goal  to  be  reached.”  And  this  leaves 
out  of  account  the  entire  field  of  medical  education, 
which  is  to  supply  the  doctors  needed. 

The  present  opportunity  is  superb  for  medical  men 
to  do  educational  work,  and  thereby  shape  the  medical 
situation  for  China.  Delay  now  means  permanent 
loss,  for  when  China  has  organized  her  own  medical 
institutions,  the  opportunity  will  be  forever  gone. 
The  need  of  uniting  all  available  forces  in  establish- 
ing union  medical  schools  in  strategic  centers,  in  order 
that  the  limited  foreign  funds  and  men  may  be  fully 
conserved,  has  already  been  sufficiently  urged,  and 
several  such  schools  are  now  in  operation.  The  pur- 
pose of  this  paper  is  to  invite  serious  attention  to  a 
working  example  of  cooperation  with  the  Chinese  in 
medical  education  on  a new  basis. 


* Read  before  biennial  convention  of  China  Medical  Association, 
Shanghai,  Feb.  1-5,  1915. 


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The  advantages  of  such  cooperation  arc : 

1.  The  good  will  of  the  Chinese  is  enlisted.  When 
they  are  made  partners,  opposing  forces  are  changed 
into  promoting  ones. 

2.  Suspicion  is  removed.  Cooperation  brings  closer 
touch  with  the  Chinese  and  a truer  understanding  of 
the  real  purpose  of  missionaries  in  China,  thus  avert- 
ing the  besetting  dread  of  the  Chinese  of  foreign 
aggression  in  educational  work.  The  result  is 
increased  confidence  in  foreigners  and  their  activities 
and  motives. 

3.  The  advice  and  practical  aid  of  the  Chinese  work- 
ers is  indispensable  in  adapting  such  institutions  to 
Chinese  requirements.  Only  a Chinese  can  fully 
understand  the  Chinese  point  of  view. 

4.  Cooperation  with  the  Chinese  gives  the  work 
more  permanency.  In  medical  as  in  other  lines,  for- 
eigners are  merely  laying  foundations  on  which  the 
Chinese  themselves  must  build.  By  cooperation  alone 
is  the  work  made  continuous  and  lasting. 

5.  Through  cooperation  the  Chinese  learn  the  best 
methods  of  conducting  schools,  and  foreign  educators 
are  enabled  to  direct  the  proper  expenditure  of  funds. 

6.  With  government  recognition,  the  work  is  viewed 
with  favor  by  the  Chinese. 

There  are,  to  be  sure,  certain  disadvantages,  but 
the  merits  of  cooperation  vastly  overbalance  these,  and 
in  most  cases  the  difficulties  are  easily  overcome.  Hav- 
ing enumerated  the  advantages  of  cooperation  with 
the  Chinese,  let  me  describe  to  you  a cooperative 
agreement  at  Changsha  between  the  Chinese  and  Yale 
which  is  now  in  full  operation.  Those  who  are  seek- 
ing examples  of  such  cooperation  may,  perhaps,  profit 
from  the  recital  of  an  actual  experience. 

This  movement  took  a practical  form  in  the  summer 
of  1913,  but  Yale  had  been  patiently  and  carefully 
paving  the  way  since  1906.  During  these  years  the 
one  aim  was  to  cultivate  friendship  and  good  will 
with  the  Chinese,  and  to  win  Chinese  interest  and 
confidence  in  the  Yale  work.  To  this  end,  every  effort 
was  made  to  give  practical  assistance  to  the  Chinese 
in  such  affairs  as  Red  Cross  work,  combatting  epidem- 
ics, and  in  making  effective  sanitary  reforms.  So  in 
1913,  when  a large  gift  was  secured  in  America  for 


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the  erection  of  a new  Yale  hospital,  the  Chinese  were 
at  once  interested,  and  appreciated  the  opportunity. 
On  their  own  initiative,  over  eighty  of  the  prominent 
gentry  of  Hunan,  led  by  provincial  officials,  sent  a 
joint  petition  to  the  governor,  requesting  him,  in  the 
name  of  the  Hunan  government,  to  enter  into  a work- 
ing agreement  with  Yale  for  the  immediate  establish- 
ment of  a medical  school.  This  request  was  granted, 
and  the  agreement  was  signed  in  July,  1913,  between 
Yale  on  the  one  side  and  the  governor  representing 
the  Hunan  government  on  the  other.  Thus  was  born 
the  Hunan  Yale  Medical  School. 

1 wish  again  to  emphasize  the  fact  that  the  coop- 
erative agreement  was  developed  at  the  initiative  of 
the  Chinese,  but  that  the  way  was  paved  by  a stead- 
fast and  definite  policy  on  the  part  of  Yale  extending 
over  seven  years.  In  addition  to  opening  a new  medi- 
cal school,  with  standards  similar  to  those  in  the 
West,  the  cooperation  also  undertook  to  maintain  two 
nursing  schools  for  men  and  women,  respectively,  a 
hospital  and  a research  department  for  the  investiga- 
tion of  public  health  problems  and  diseases  peculiar 
to  China.  By  the  agreement,  the  Hunan  government 
is  to  provide  the  necessary  school  buildings,  costing 
$156,000  (Mexican),  nine  acres  of  land,  amounting 
to  $50,000,  and  an  annual  sum  of  $50,000  (Mexican) 
for  the  maintenance  of  the  school  and  hospital.  Yale 
undertook  to  furnish  a hospital  costing  $150,000  gold, 
and  the  salaries  of  fifteen  doctors. 

Control  is  vested  in  a board  of  managers  of  twenty 
members,  ten  Chinese  and  ten  from  Yale.  The  board, 
when  formed,  is  self-perpetuating,  but  undesirable 
members  may  be  removed  by  a three-fourths  vote 
of  the  board.  In  case  of  vacancy,  the  board  has  the 
right  to  elect  new  members,  but  such  elections  re- 
quire a three-fourths  vote  of  the  members  to  become 
valid.  Current  business  is  in  the  hands  of  an  execu- 
tive committee,  elected  by  and  from  the  managers. 
The  agreement  provides  for  a probationary  period  of 
ten  years,  and  is  subject  to  indefinite  continuation,  if 
proved  successful.  Land  costing  80,000  taels  has  been 
purchased  adjoining  the  Yale  campus.  Of  this  sum 
''tale  gave  20,000  taels,  the  Hunan  government  50,000 
taels,  and  the  land  owners  10,000  taels.  A medical 


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preparatory  department  and  two  nurses'  training 
schools  were  opened  in  the  fall  of  1913. 

Before  the  agreement  was  put  to  a practical  test, 
it  was  feared  by  Yale  that  certain  delicate  matters 
would  present  practical  difficulties.  One  of  these 
problems  was  in  connection  with  religious  instruction, 
but  the  difficulty  was  easily  met  by  a clause  insisting 
on  the  importance  to  the  society  that  physicians  should 
be  men  of  moral  character,  and  providing  that,  while 
students  were  to  have  entire  religious  freedom,  teach- 
ers were  also  to  be  free  to  give  religious  instruction. 
With  a board  whose  Chinese  representatives  were 
chiefly  non-medical  men,  it  was  feared  that  unreason- 
able interference  on  technical  matters  might  impair 
the  efficiency  of  the  school ; but  it  was  soon  found  to 
be  quite  otherwise.  The  Chinese  members  voluntarily 
placed  the  entire  responsibility  in  technical  matters 
in  the  hands  of  the  Yale  medical  staff.  Besides,  the 
rules  of  the  Hunan  Yale  Medical  Association  provide 
that  professional  management  of  the  hospital  and 
school  shall  be  left  with  the  two  medical  members  on 
the  committee. 

The  appointment  and  dismissal  of  teachers,  it  was 
feared,  might  become  another  serious  difficulty.  The 
Chinese  might  introduce  their  own  friends,  regardless 
of  qualifications.  But  this  fear  was  removed  by  leav- 
ing nomination  for  appointments  entirely  in  the  hands 
of  the  two  medical  members  of  the  executive  comit- 
tee,  and  making  dismissal  of  teachers  require  a three- 
fourths  vote  of  the  board  of  managers,  on  the  recom- 
mendation of  the  medical  faculty. 

The  difficulty  of  the  language  to  be  used  as  a teach- 
ing medium  was  also  readily  solved.  The  opinion  of 
the  Chinese  managers  was  asked,  and  their  decision 
was  unanimous  that  English  should  be  employed.  It 
seemed  evident  to  them  that  the  difficulties  in  giving 
adequate  medical  instruction  in  Chinese,  and  the  ideal 
of  making  this  a first-class  medical  school,  alike  made 
the  use  of  English  imperative.  Of  course  the  pre- 
medical course,  and  perhaps  part  of  the  lower  years  of 
the  medical  course,  would  require  more  or  less  explan- 
atory instruction  in  Chinese ; but  the  opinion  was 
unanimous  and  enthusiastic  on  the  part  of  the  Chinese 
that  graduates  should  have  a good  working  knowledge 


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of  English  and  that  the  more  technical  instruction 
should  be  in  English. 

In  the  midst  of  progress  there  came  a serious  set- 
back. A small  group  of  Chinese,  claiming  to  repre- 
sent the  western  medical  profession  £>f  the  province, 
from  motives  of  jealousy  and  self-interest,  attempted 
to  wreck  the  Hunan- Yale  scheme.  At  a time  when 
Hunan  was  suffering  from  the  effects  of  her  declara- 
tion of  independence  from  the  central  government 
(August,  1913),  it  seemed  easy  to  ruin  the  scheme. 
The  governor  who  had  put  the  agreement  through 
lost  favor  at  Peking  and  was  removed.  This  gave  the 
opposition  its  opportunity  at  Peking,  and  a decision 
of  the  cabinet  ordered  the  Hunan-Yale  agreement  to 
be  canceled.  For  a time  difficult  problems  confronted 
Yale.  Analysis  of  the  situation  resolved  it  into  two 
propositions  : 

1.  Was  it  worth  while  to  revive  the  cooperation, 
if  an  agreement  officially  made  with  the  Hunan  gov- 
ernment could  be  so  easily  canceled  at  Peking? 

2.  If  worth  reviving,  should  Yale  bring  diplomatic 
pressure  to  bear  at  Peking,  or  should  the  Chinese  use 
their  persuasive  influence  on  their  own  cabinet? 

Yale  unanimously  decided  to  adopt  the  latter  policy 
in  the  belief  that  if  the  movement  could  not  be  revived 
by  reasonable  explanation,  no  real  cooperation  could 
take  place. 

After  securing  the  approval  of  the  new  governor, 
who  quickly  became  a warm  friend  of  the  movement, 
representatives  were  sent  to  Peking  to  ascertain  the 
nature  of  the  opposition.  They  found  that  the  objec- 
tions, which  were  largely  misrepresentations  by  the 
opposing  party,  were  easily  explained.  Only  one  real 
issue  was  raised  by  the  Peking  government.  Since 
the  movement  was  the  first  of  its  kind,  representing 
the  cooperation  of  a private  foreign  body  with  a pro- 
vincial government,  Peking  feared  that  it  might  later 
be  used  as  a precedent  by  other  foreign  organizations 
whose  motives  might  not  be  so  sincere  as  those  of 
Yale.  Consequently,  the  services  of  thirty  leading 
Hunan  officials  resident  in  Peking  were  secured  to 
organize  an  association  known  as  the  Hunan-Ru’- 
thuen  Educational  Association,  and  an  agreement 
similar  to  the  original  one  was  signed  between  it  and 
Yale.  The  agreement  met  the  formal  approval  and 


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sanction  of  the  cabinet,  as  well  as  of  the  Boards  of 
Education,  Finance,  the  Interior,  and  Foreign  Affairs. 
The  Ru’-chuen  Association  thus  acts  as  a technical 
intermediary  between  the  government  and  Yale.  All 
the  financial  undertakings  called  for  in  the  agreement 
are,  in  reality,  carried  by  the  government. 

Thus  the  Hunan-Yale  Medical  School  was  revived. 
This  time  it  has  been  placed  on  a still  firmer  basis 
because  it  has  been  registered  with  the  central  govern- 
ment as  well  as  with  the  governor  of  the  province. 
The  cooperation  is  made  stronger  and  more  real 
because  no  foreign  pressure  was  used  in  its  revival. 
The  movement  has  stood  a severe  testing.  It  was 
subjected  to  the  scrutiny  of  the  cabinet  twice,  was 
approved  by  three  governors,  and  supported  by  two 
parties  of  opposite  political  views.  The  fact  is  sig- 
nificant that  though  at  present  the  provincial  treasury 
is  depleted,  and  though  the  authorities  are  trying  in 
every  way  to  reduce  expenses,  educational  and  of 
other  sorts,  yet  they  are  sincere  in  their  desire  to  dis- 
charge their  obligation  to  the  Hunan-Yale  Medical 
School.  Two  payments  totaling  $20,000  have  been 
made,  and  a large  building  worth  $50,000  has  been 
reserved  for  the  use  of  the  school  and  hospital,  pend- 
ing the  erection  of  permanent  buildings. 

The  medical  preparatory  school  with  nineteen  stu- 
dents, and  the  two  nursing  schools  with  thirty-five  stu- 
dents, are  now  in  full  operation,  and  the  Yale  hospital 
is  under  the  direction  of  the  joint  board.  This  repre- 
sents the  Hunan-Yale  cooperation  in  medical  educa- 
tion. It  is  taking  place  in  Hunan,  a province  in  which 
provincialism  and  local  pride,  to  say  nothing  of 
nationalism,  run  high.  If  it  is  possible  in  Hunan,  it 
must  be  possible  in  many  other  places  in  China.  The 
time  has  come  when  the  Chinese  look  on  cooperation 
with  favor.  Where  it  is  sought  it  will  be  found ; but 
progress  must  be  patient  and  slow,  if  lasting  results 
are  to  be  obtained.  The  first  essential  is  to  remove 
all  opposition,  and  to  secure  the  friendship,  good  will 
and  sympathy  of  the  Chinese.  To  overcome  opposi- 
tion, the  resources  of  Chinese  friends  must  be  sought. 
One  man  who  has  made  friends  out  of  opponents  for 
the  work  in  Changsha  is  an  elderly  Chinese  doctor 


/ 


who  has  made  both  fame  and  fortune  in  the  practice 
of  Chinese  medicine.  When  he  was  won  over  he  gave 
up  his  lucrative  practice  and  resigned  the  presidency 
of  a Chinese  medical  school.  Not  only  does  he  lend 
financial  and  moral  aid  to  the  Hunan-Yale  school,  but 
he  sends  many  rich  and  influential  patients  to  the  hos- 
pital and  on  every  occasion  testifies  to  his  conviction 
that  Western  medicine  is  better  than  Chinese. 

When  opposition  is  removed,  indifference  and  apathy 
must  be  transformed  into  keen  and  proprietary  inter- 
est. Indifferent  cooperation  is  not  productive  of 
effective  results.  Unless  the  Chinese  have  an  intense 
and  vital  interest  aroused,  cooperation  is  in  name  only. 
Here  are  needed  those  Chinese  who  command  esteem 
and  respect  among  their  countrymen.  Revival  of  the 
Hunan-Yale  movement  would  have  been  difficult  with- 
out such  Chinese  as  General  L.  Chang,  who  from  long 
contact  with  foreign  institutions  knew  exactly  what 
they  stood  for, 'and  from  his  important  official  posi- 
tion as  military  adviser  to  the  president,  commanded 
the  oonfidence  of  the  people.  Because  of  this,  he  was 
able  to  convert  the  previously  uninterested  officials  in 
Peking  into  actual  promoters  of  the  movement.  At 
Changsha  Yale  is  fortunate  in  having  another  friend, 
the  son  of  a governor,  whose  close  connection  with 
the  gentry  gives  him  great  influence  with  his  fellow 
provincials.  Three  principals  of  the  three  most  impor- 
tant middle  schools,  as  well  as  the  commissioners  of 
education  and  police,  are  among  the  members  of  the 
board  of  managers.  Indeed,  the  strongest  asset  of  the 
Hunan-Yale  Medical  School  is  the  great  and  practica1 
interest  taken  in  its  work  by  the  Chinese  members  of 
the  board.  This  interest  has  been  worked  no  by  this 
one  man. 

Hunan-Yale  represents  a thorough  and  wholesale 
cooperation  in  medical  education  with  the  Chinese.  It 
is  a brave  attempt  in  that  its  success  is  yet  to  be 
proved.  It  is  a risky  enterprise  in  that  the  coalition 
has  yet  unforeseen  difficulties  to  face.  It  means  self- 
denial  and  sacrifice  on  the  part  of  the  foreigners  con- 
cerned, but  it  is  worthy  of  the  most  serious  considera- 
tion. The  time  has  come  when  cooperation  with  the 
Chinese  is  no  longer  an  ideal  dream  but  may  be  mate- 
rialized in  fact.  The  Chinese  are  getting  to  know 
the  foreigners  better,  and  to  understand  their  real 


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motives,  and  are  prepared  to  unite  with  them  in  such 
movements  as  this.  But  the  initiative  must  come  from 
foreigners.  Where  cooperation  is  sought,  it  is  given, 
but  the  degree  of  success  must  necessarily  depend 
on  the  spirit  in  which  it  is  entered.  In  proportion 
to  the  fairness,  loyalty  and  enthusiasm  of  the  foreign 
party  will  he  the  cordiality,  interest  and  support  of 
the  Chinese. 


